老年2型糖尿病合并慢性肾脏病患者肠道菌群变化

Changes of intestinal flora in elderly patients with type 2 diabetes mellitus complicated with chronic kidney disease

目的探讨合并慢性肾脏病的老年2型糖尿病患者肠道菌群变化情况,为后续研究提供参考。方法选择2018年11月至2019年7月在我院内科确诊的老年2型糖尿病及并发慢性肾脏病患者作为糖尿病组(20例)及糖尿病肾病组(20例),选择本院健康老年体检者(30例)为对照组。测定各组对象血清甲状旁腺激素(PTH)、超敏C反应蛋白(hs-CRP)、血肌酐(Scr)、血磷(P)、血钙(Ca^(2+))、碱性磷酸酶(ALP)、糖化血红蛋白(HbA1c)水平,同时分析各组对象肠道大肠埃希菌、双歧杆菌、乳杆菌、酵母菌、真杆菌的差异。结果糖尿病肾病组患者肠道大肠埃希菌数量高于糖尿病组和对照组,糖尿病组患者肠道大肠埃希菌数量高于对照组(均P<0.05)。糖尿病肾病组患者肠道双歧杆菌、真杆菌数量低于糖尿病组和对照组,同时糖尿病组患者肠道双歧杆菌、真杆菌数量低于对照组(均P<0.05)。糖尿病肾病组患者血清Scr、P、Ca^(2+)水平高于糖尿病组和对照组,糖尿病组患者血清Scr、P、Ca^(2+)水平高于对照组(均P<0.05)。糖尿病肾病组患者血清HbA1c、ALP、hs-CRP水平高于糖尿病组和对照组,同时糖尿病组患者血清HbA1c、ALP、hs-CRP水平高于对照组(均P<0.05)。大肠埃希菌数量与Scr、P、Ca^(2+)、HbA1c、ALP、hs-CRP水平呈正相关,双歧杆菌、真杆菌数量与Scr、P、Ca^(2+)、HbA1c、ALP、hs-CRP水平呈负相关(均P<0.05)。大肠埃希菌数量升高(OR=4.26,95%CI:1.87~9.71),双歧杆菌(OR=5.02,95%CI:2.36~10.68)和真杆菌(OR=17.89,95%CI:12.67~25.89)数量降低均为糖尿病并发慢性肾病的危险因素。结论糖尿病肾病患者肠道菌群失调,其特征为大肠埃希菌数量增多,双歧杆菌、真杆菌数量减少。大肠埃希菌数量升高,双歧杆菌和真杆菌数量降低均为糖尿病并发慢性肾脏病的危险因素。

Objective To observe the changes of intestinal flora in elderly patients with type 2 diabetes mellitus(T2 DM) complicated with chronic kidney disease(CKD), and provide a reference for the following research. Methods From November 2018 to July 2019, elderly patients diagnosed as T2 DM complicated with kidney disease in our hospital were enrolled and divided into the diabetic group(20 cases) or the diabetic nephropathy group(20 cases). Thirty healthy elderlies were enrolled as control group. The levels of parathyroid hormone(PTH), hypersensitive C-reactive protein(hs-CRP), serum creatinine(Scr), blood phosphorus(P), blood calcium(Ca^(2+)) and alkaline phosphatase(ALP) and the counts of intestinal E. coli, Bifidobacteria, Lactobacillus, yeast and Mycobacteria were detected in the 3 groups. Results The count of E. coli in the diabetic nephropathy group was higher than in the diabetic group and control group respectively, and that in the diabetic group was higher than in the control group(all P<0.05). The counts of Bifidobacteria and Bacillus in the diabetic nephropathy group were lower than in the diabetic group and control group respectively, and those in diabetic group were lower than in the control group(all P<0.05). The levels of Scr, P and Ca^(2+) in diabetic nephropathy group were higher than those in diabetic group and control group respectively, and those in diabetic group were higher than in control group(all P<0.05). The levels of HbA1 c, ALP and hs-CRP in diabetic nephropathy group were higher than in diabetic group and control group respectively, and those in diabetic group were higher than in control group(all P<0.05). The positive correlation between the count of E. coli and levels of Scr, P, Ca^(2+), HbA1 c, ALP and hs-CRP were significant. The negative correlation between the counts of Bifidobacteria and Bacillus and levels of Scr, P, Ca^(2+), HbA1 c, ALP and hs-CRP were significant(all P<0.05). The increasing count of E. coli(OR=4.26, 95% CI: 1.87-9.71) and decreasing counts of Bifidobacteria(OR=5.02, 95% CI: 2.36-10.68) and Bacillus(OR=17.89, 95% CI: 12.67-25.89) were the risk factors for diabetic nephropathy. Conclusion Disorder of intestinal flora in patients with diabetic nephropathy is characterized by an increase in the count of E. coli and decrease in the counts of Bifidobacteria and Bacillus.The increasing count of E. coli and decreasing counts of Bifidobacteria and Bacillus are the risk factors for chronic diabetic nephropathy.